Feasibility and efficacy of a digital cognitive behavioural therapy program for insomnia and anxiety for older adults
Bibliographic record
Abstract
ABSTRACT Insomnia and anxiety are highly prevalent and often comorbid in older adults. Although cognitive-behavioural therapy is the first-line treatment for insomnia, few interventions simultaneously address both conditions. Furthermore, access remains limited by provider availability and high costs. To address these gaps, we developed an online CBT program for insomnia and anxiety (eCBT+). This randomized controlled trial aimed to assess the usability and acceptability of the eCBT+ program and evaluate its efficacy in older adults with insomnia. Eighty older adults with insomnia were randomized to the eCBT+ intervention ( n =38) or a waitlist (WL) control condition ( n =42). Platform usability and program acceptability were assessed post-intervention using the System Usability Scale (SUS) questionnaire and the extended Technology Acceptance Model questionnaire. Insomnia and anxiety symptoms evaluated with the Insomnia Severity Index (ISI) and Geriatric Anxiety Inventory (GAI) respectively, along with sleep-diary sleep efficiency, were assessed at baseline and follow-up. Linear mixed models with an intention-to-treat approach assessed the Group*Time interaction. The platform was considered user-friendly (SUS=69.94%). Perceived ease of use, perceived usefulness, and result demonstrability were the main contributors to acceptability. The eCBT+ group showed reduced ISI and GAI and increased sleep efficiency, from baseline to follow-up, compared to the WL group ( ps < .001). The eCBT+ program was user-friendly and its use was acceptable in older adults with insomnia. The program improved sleep efficiency and reduced insomnia and anxiety symptoms, demonstrating the efficacy of our eCBT+ intervention. Web-based tools offer a promising approach to promote sleep and mental health among older adults. ( https://www.isrctn.com/ISRCTN15338211 ) KEYPOINTS ■ This randomized controlled trial evaluated the feasibility and efficacy of a digital cognitive behavioural therapy program for insomnia and anxiety, delivered through a platform tailored to older adults. ■ The platform was well accepted and considered user-friendly, with acceptability primarily explained by perceived ease of use, perceived usefulness and demonstrability of results. ■ The intervention demonstrated efficacy by improving sleep efficiency and reducing insomnia and anxiety symptoms. ■ This combined digital cognitive behavioural therapy for insomnia and anxiety represents an innovative, clinically relevant and accessible approach for older adults.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".